Deck 13: Government Incentive Programs

Question 1

The typical pay-for-performance program will provide a bonus to healthcare providers for meeting or exceeding agreed upon:

A) quality measures.
B) performance goals.
C) expense management.
D) both quality measures and performance goals.
E) None of these is correct.

Answer 1

D

Question 2

_____________________ is where the healthcare provider is measured on the effectiveness of the care provided.

A) Process
B) Outcome
C) Patient experience
D) Structure
E) All of these are correct.

Answer 2

B

Question 3

_____________________ measures how well the facilities, equipment, and personnel were used in the treatment of the patient.

A) Process
B) Outcome
C) Patient experience
D) Structure
E) All of these are correct.

Answer 3

D

Question 4

There are Public Sector initiatives that include _________________ that have been the leaders in the P4P environment.

A) Medicare, Medicaid, and Commercial Insurances
B) Medicare
C) Medicare and Medicaid
D) Commercial Insurances

Question 5

Quality indicators (QI) and process measures have been developed for the healthcare industry and are continually being refined. These measures, such as __________, increase consumer awareness.

A) web-based portals
B) reduced customer awareness
C) shorter waiting times
D) CPOE

Question 6

The ____________________________ covers "nurse communication, doctor communication, hospital staff responsiveness, pain management, medicine communication, hospital cleanliness and quietness, discharge information, and overall hospital rating."

A) Clinical Process of Care Domain
B) Patient Experience of Care Domain
C) Outcome
D) Efficiency Domain

Question 7

__________ covers "acute myocardial infarction (AMI) 30-day mortality rate, heart failure (HF) 30-day mortality rate, pneumonia (PN) 30-day mortality rate, complication or patient safety for selected indicators (composite), central line-associated blood stream infection."

A) Clinical Process of Care Domain
B) Patient Experience of Care
C) Outcome Domain
D) Efficiency Domain

Question 8

________________________ is where the data are captured and are different for each year.

A) Performance period
B) Calendar year
C) Fiscal year
D) Baseline period

Question 9

____________________________ is a standardized survey and data collection tool that has been used since 2006. The goal of this program is to measure the patient's perspective of the hospital care that was received.

A) HIPPS
B) HCAHPS
C) HIPAA
D) Both HIPPS and HIPAA
E) None of these is correct.

Question 10

______________ is designed to produce consistent data that can be compared by the patients to allow objective and meaningful comparisons between hospitals on topics that are important to the patient.

A) Survey
B) Public reporting
C) Public accountability
D) Less transparency

Question 11

_______________________ will enhance public accountability of the hospital as the healthcare delivery model is becoming more and more transparent.

A) Survey
B) Public reporting
C) Public accountability
D) Less transparency

Question 12

___________________________ provides accessible, continuous and coordinated, family-centered care to high-need populations under which care management fees are paid to persons performing services as personal physicians and incentive payments are paid to physicians participating in practices that provide such care.

A) PCMH
B) ACO
C) HCAHPS
D) VBP
E) P4P

Question 13

The _________________, which was created by the Affordable Care Act, is a delivery and payment incentive model that is using home-based primary care teams. These teams are focused on improving health outcomes and ultimately reducing healthcare costs for Medicare beneficiaries who have chronic conditions.

A) Patient Centered Medical Home
B) Accountable Care Organization
C) Physician Hospital Organization
D) Independence at Home Demonstration project

Question 14

To be an eligible beneficiary to participate in the Independence at Home Demonstration program, the beneficiary must have:

A) two or more chronic conditions.
B) health coverage from a Managed Care Medicare Plan.
C) no need for assistance with walking, bathing, or feeding.
D) had an elective inpatient hospital admission within the last 12 months.

Question 15

A penalty that Medicare has imposed on hospitals is when a patient acquires a pressure sore during the hospital admission, Medicare will continue to pay for the treatment of the pressure sore during the patient's hospital stay as they did in the past.

Question 16

P4P strives for "the right care for every patient every time."

Question 17

Unfortunately, Medicaid has historically had a lower reimbursement than other plans, and this has driven away providers from the plans. Even with fewer providers, Medicaid seems to get the results that other plans get with higher reimbursements.

Question 18

Return on Investment (ROI) calculators are used by P4P programs to identify the financial benefits realized, or dollars saved, by participating in these programs. These tools can also predict associated benefits by measuring lives saved or the outcomes of the program.

Question 19

The Hospital Value-Based Purchasing (VPB) Program is a CMS initiative that rewards acute-care hospitals with incentive payments based on the cost of care that they provide to the beneficiary/patient who receives Medicare while they are in their care.

Question 20

Overall, with healthcare spending out of control and deficiencies in the quality of care delivered to the patients, along with safety of care in the U.S. healthcare system, a new system needed to be developed that would improve the care delivered to the patient that would, in turn, improve the value of care delivered to the beneficiary.

Question 21

Hospitals that are excluded from the VBP Program include hospitals that are banned from the Inpatient Prospective Payment System (IPPS), any hospitals that do not participate in the IQR Program during the performance period, any hospitals that are cited for posing an immediate threat to patient health or safety, and any hospitals that do not meet the minimum standards (cases, measures, or surveys) required by the VBP Program.

Question 22

To participate in the Independence at Home Demonstration program, the practice must demonstrate that they are familiar with and have adequate experience in delivering specialty care in a patient home setting.